PTD 21
APPLICATION FOR PARTICIPATION IN W. W. 31-18-207
AND AUTHORIZATION FOR COLLECTION OF FEES IN LIEU OF REGISTRATION
ON MOBILE MACHINERY THAT IS RENTED OR LEASED
OWNER____________________________________________
TREASURERS USE ONLY
BUSINESS NAME___________________________________
Reporting Year_________________
MAILING ADDRESS________________________________
County Name___________________
CITY______________________________________________
Treasurers Authorization_________
BUSINESS ADDRESS_______________________________
Date___________________________
DESCRIPTION
YEAR
MAKE & MODEL
VIN #
SERIAL #
DECAL #
I certify that the above Mobile Machinery is held as inventory by the owner, and will be leased or rented for periods
of at least 60 days in duration.
Signature_______________________________________ Title_____________________________ Date__________
Signature of owner or authorized agent
COPY:
COUNTY WHERE MOBILE MACHINERY WAS USED WITH REMITTANCE DUE FOR THAT COUNTY
COUNTY THAT ISSUED THE DECALS